Claims Investigation Agent

at  Commonwealth of PA

THE POSITION

Do you enjoy investigative and analytical work? The Department of Human Services (DHS), Division of Third Party Liability in the Bureau of Program Integrity is searching for a Claims Investigation Agent to join their team of professionals. As a member of the team, you will recover medical assistance expenditures that were incorrectly or provisionally paid on behalf of Department of Human Services recipients. Apply today to embark on a fulfilling journey!

DESCRIPTION OF WORK

As a Claims Investigation Agent, you will communicate legal authority to recover medical assistance funds. In this process, you will conduct a review of all documents from attorneys and insurance companies. You will research all possible sources for recovery of medical assistance funds, notify relevant parties of DHS interest, and initiate request of medical claims for review. You will also follow-up to ensure payment of the department’s claim. In this role, you must maintain a working knowledge of the laws and regulations in relation to medical assistance fund recovery.
Interested in learning more? Additional details regarding this position can be found in the position description.

MINIMUM EXPERIENCE AND TRAINING REQUIREMENTS:

• Four years of investigative public contact experience requiring the review and presentation of records, correspondence and documents used in the prosecution of cases, approval of claims or credit, or collection of debts; or
• A bachelor’s degree in Pre-law, Criminal Justice, Police Science, or a closely related field; or
• Any equivalent combination of experience and training.

OTHER REQUIREMENTS:

• You must meet the PA residency requirement. For more information on ways to meet PA residency requirements, follow the link and click on Residency.
• You must be able to perform essential job functions.

Please refer the Job description for details